Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Neuropsychiatry

Objectives: To identify the relationship between fatigue associated with multiple sclerosis (MS) and frontal white matter (WM) integrity through the study of the relationship between fatigue and frontal WM fractional anisotropy (FA) measured with Diffusion Tensor Imaging (DTI). Methods: The study was conducted on 33 patients with relapsing remitting MS and 13 healthy controls. All patients were subjected to the detailed neurological evaluation, Expanded Disability Status Scale (EDSS) and Fatigue Severity Scale (FSS). Patients were grouped according to FSS into fatigued (FSS {u2265} 4; n=15) and non-fatigued (FSS > 4; n=18) subgroups. Beck's Depression Inventory was used to exclude patients with clinically relevant depression. Using DTI, FA was measured to determine frontal WM integrity. Results: Fatigued MS patients presented with older age (p {u02C2}0.001), longer disease duration (p = 0.02) and lower FA values (p {u2264} 0.002) than non-fatigued patients. No differences in fatigue related to gender among MS patients. FSS scores were correlated with measured FA values in right (p {u02C2}0.001, r = {u2013} 0.627) and left (p {u02C2}0.001, r = {u2013} 0.758) frontal WM, age (p < 0.025, r =0.391) and disease duration (p = 0.015, r = 0.418) but not with EDSS. Compared with controls, all MS patients showed lower FA values (p {u02C2}0.001).Conclusion: MS related fatigue is likely to be the result of regional disruption of frontal white matter networks. It is more severe with older age and longer disease duration. It is independent of disability and gender

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